Alpha-fetoprotein-producing esophageal adenocarcinoma: a mimicker of hepatocellular carcinoma

Combined tubular adenocarcinoma, neuroendocrine carcinoma and adenocarcinoma with enteroblastic differentiation arising in Barrett esophagus

Adenocarcinoma (AC) with neuroendocrine carcinoma (NEC) or enteroblastic (ENT) differentiation rarely develops in Barrett's esophagus (BE). A 76-year-old man was diagnosed with Barrett's AC (cT1bN0M0) and underwent thoracoscopic esophagectomy. A type 0-IIc + 0-Is lesion measuring 26 × 21 mm was macroscopically observed on a background of long segment BE (pT1bN0M0). The tumor comprised three different histological types of carcinoma (NEC, AC with ENT differentiation and moderately differentiated AC). NEC showed positivity for synaptophysin, chromogranin A and insulinoma-associated protein 1 with a Ki-67 index of 60.6%. ENT tumors were immunopositive for AFP and sal-like protein 4, and focally immunopositive for human chorionic gonadotrophin. The amounts of NEC, ENT and AC were 40%, 40% and 20%, respectively. p53 expression was positive throughout the tumor. Rb expression was negative at the NEC, but positive at the ENT and AC. CD4 and CD8 densities were lower in the NEC segment than in the AC and ENT segments, and PD-L1 expression was negative throughout the tumor. Early cancer arising in BE with a combination of tubular AC, ENT tumors and NEC is very rare. Our observations might contribute to understanding the carcinogenetic pathways and tumor microenvironment of NEC and ENT tumors.

Alpha-Fetoprotein-Producing Esophageal Adenocarcinoma With Enteroblastic, Yolk Sac Tumor-Like, and Hepatoid Carcinoma Differentiation: A Rare Case and Literature Review

We report a case of a 65-year-old man with alpha-fetoprotein (AFP)-producing esophageal adenocarcinoma that microscopically consisted of a polymorphous blend of enteroblastic, yolk sac-like, and hepatoid carcinoma components of variable proportions. No histological evidence of Barrett's esophagus was identified. Two weeks post-endoscopic mucosal mass resection, the serum AFP level was 1434.6 ng/mL. The patient underwent radiation and chemotherapy but developed metastatic lung lesions. At 18 months post-resection, the patient is alive. AFP-producing esophageal adenocarcinoma is a rare entity. We reviewed reported cases for clinicopathological features, treatment strategies, and prognosis.

Quantitative Detection of Gastrointestinal Tumor Markers Using a Machine Learning Algorithm and Multicolor Quantum Dot Biosensor

This work was to explore the application value of gastrointestinal tumor markers based on gene feature selection model of principal component analysis (PCA) algorithm and multicolor quantum dots (QDs) immunobiosensor in the detection of gastrointestinal tumors. Based on the PCA method, the neighborhood rough set algorithm was introduced to improve it, and the tumor gene feature selection model (OPCA) was established to analyze its classification accuracy and accuracy. Four kinds of coupled biosensors were fabricated based on QDs, namely, 525 nm Cd Se/Zn S QDs-carbohydrate antigen 125 (QDs525-CA125 McAb), 605 nm Cd Se/Zn S QDs-cancer antigen 19-9 (QDs605-CA19-9 McAb), 645 nm Cd Se/Zn S QDs-anticancer embryonic antigen (QDs 645-CEA McAb), and 565 nm Cd Se/Zn S QDs-anti-alpha-fetoprotein (QDs565-AFP McAb). The quantum dot-antibody conjugates were identified and quantified by fluorescence spectroscopy and ultraviolet absorption spectroscopy. The results showed that the classification precision of OPCA model in colon tumor and gastric cancer datasets was 99.52% and 99.03%, respectively, and the classification accuracy was 94.86% and 94.2%, respectively, which were significantly higher than those of other algorithms. The fluorescence values of AFP McAb, CEA McAb, CA19-9 McAb, and CA125 McAb reached the maximum when the conjugation concentrations were 25 µg/mL, 20 µg/mL, 30 µg/mL, and 30 µg/m, respectively. The highest recovery rate of AFP was 98.51%, and its fluorescence intensity was 35.78 ± 2.99, which was significantly higher than that of other antigens (P < 0.001). In summary, the OPCA model based on PCA algorithm can obtain fewer feature gene sets and improve the accuracy of sample classification. Intelligent immunobiosensors based on machine learning algorithms and QDs have potential application value in gastrointestinal gene feature selection and tumor marker detection, which provides a new idea for clinical diagnosis of gastrointestinal tumors.

Alpha-fetoprotein-producing advanced colorectal cancer: a rare case report and literature review

Alpha-fetoprotein(AFP)-producing colorectal cancer is a rare form of colorectal cancer with a high degree of malignancy, advanced stage, strong invasiveness, poor response to treatment, rapid progression, and poor prognosis. Herein, we present the case of a middle-aged (in his 50s) male patient who underwent left neck lymph node biopsy due to "left neck lymph node enlargement for 5 months." Biopsy results revealed metastatic adenocarcinoma, and computed tomography examination of the chest and abdomen suggested a malignant tumor of the sigmoid colon with multiple metastases. Subsequently, the patient underwent colonoscopy, and the pathological result was colonic adenocarcinoma. Regarding tumor markers, serum alpha-fetoprotein (AFP) was 214 ng/mL. The patient received first- and second-line treatments for colon cancer, but progression-free survival was short. AFP was consistently elevated; after 8 months, the patient had AFP levels of 11,371.8 ng/mL, and imaging confirmed disease progression. The patient subsequently died, with an overall survival of more than 9 months. Compared with other tumor markers, AFP better reflects tumor progression in AFP-producing colorectal cancer.

An Extremely Rare Presentation of an Alpha-Fetoprotein-Producing Esophageal Adenocarcinoma

Alpha-fetoprotein (AFP)-producing esophageal adenocarcinoma (EAC) is an extremely rare occurrence with very few cases reported in the literature. We report the case of a 76-year-old female who presented with progressive weakness, fatigue, and a decrease in appetite for weeks and who was found to have an AFP-producing EAC with an extraordinarily high AFP level of 46,135 ng/mL. CT angiography revealed abnormal thickening of the esophagus and multiple metastatic masses throughout the liver. Upper endoscopy revealed a large mass in the distal esophagus with extension into the stomach. Biopsy confirmed the EAC. Most cases are unsuccessfully treated with surgery and chemotherapy. Serial measurement of serum AFP may be useful for monitoring clinical status and treatment response.

Multimodality Therapy Including Proton Beam Therapy for AFP Producing Esophageal Cancer with Multiple Liver Metastases

A 50-year-old man who presented with a fever and epigastralgia was diagnosed to have esophageal carcinoma which was identified as poorly differentiated adenocarcinoma producing alpha-fetoprotein (AFP) with Barrett's esophagus. Computed tomography revealed multiple liver metastases and lymph node metastases surrounding the stomach. We first performed chemotherapy for the systemic lesions and proton beam therapy for the local control of lesions without complete remission and we were able to successfully control the frequently recurring lesions by proton beam therapy, cryotherapy and chemotherapy. A complete response has been maintained for 16 months and the overall survival time is 4 years and 2 months. Proton beam therapy for primary esophageal cancer and metastatic lesions was thus found to be an effective therapeutic option for such cases.